Data Analytics: Health Data Should be Used For More Than Just Keeping Score

From ChamberChoice and Smart Business Pittsburgh

Benefits consultants use data as a part of the consulting services provided to employers. The consulting strategy includes looking at health claims throughout the benefits year, creating reports and reviewing the reports with the benefits administration team.

“But this approach of simply ‘keeping score’ of data doesn’t accomplish the goals of every employer, which is to drive down the costs of a health insurance program,” says Michael Galardini, director of sales at JRG Advisors. “The next generation benefits consultant uses predictive modeling and data analytics to lower the largest cost of a health insurance program: emerging claims.”

Smart Business spoke with Galardini about how employers can get better results with emerging claims to lower the costs of a health insurance program.

How can predictive modeling and data analytics software identify risks andimprove a health insurance program?
Predictive modeling and data analytics software is a population health management service that can identify the high-risk members of a health insurance program.

Once identified, these members are ranked by severity and gaps in care. A web-based reporting system will provide access to the actionable information to target these high-cost and high-risk members. The system reveals the members who are noncompliant with preventive care — and members who require disease management, prescription drug maintenance or health coaching intervention.

Managing this data properly can ensure that these high-risk members don’t fall through the cracks.

Once properly identified, the next step in the risk management strategy is to evaluate the actual cost and forecast the cost in the next 12 months for each member. These include things like the number of emergency room and inpatient stays for each member in the next year. By identifying and evaluating these emerging claims, consultants can now get ahead of the costs that are driving the increases in premiums.

What’s the benefit for employers?
Identifying and managing these claims helps stabilize or lower the premium costs. The old process of reviewing claims data after the claim already occurs doesn’t allow the benefits consultant to provide a strategy to mitigate the costs to the employer.

Using predictive modeling and data analytics to identify high-risk members gives time to develop a population health management strategy to better manage the emerging claims.

What is population health management?
A significant component of reducing the identified health risk is using care managers to work with high-cost and high-risk members. Benefits consultants partner with care managers to review the data provided by the predictive modeling and data analytics software to motivate these members to manage their health care. Care managers can work directly and confidentially with the members to ensure the proper medical care is being provided for their specific medical conditions. These members will be guided through actions, such as timely preventive care, prescription drug adherence and coordination of care.

How do employees benefit?
The goal of the care managers is to teach the high-cost and high-risk members to self-manage their health care, comply with care instructions and pursue ways to improve their health status. Care managers can also use cost transparency tools to guide the member to find the best price for medical services. This not only keeps the claims costs lower for the health insurance plan, but also can help lower out-of-pocket costs the member has in the form of a deductible or co-insurance.

Incorporating predictive modeling and data analytics with a population health management strategy can produce the result that every employer expects from a benefits consultant — disrupting the current distribution model to move the needle of the emerging claims to lower the costs of a health insurance program.

Leadership Central Penn Gets Political

L-R: State Sen. John Gordner; Daniel McGann, Berwick School Board; Ken Holdren, Montour County Commissioner; State Rep. David Millard

So you think you know what LCP stands for. So did the class participants. That might have been true until arriving at Central Susquehanna Community Foundation in Berwick for February’s class when LCP stood for legacy, change and politics.  Punxsutawney Phil was seen this month, and the class welcomed back Tina Welch of Welch Performance Consulting for the Morning Motivation.  The class prepared to meet the panel of political representatives from local council, school board, county commissioner, PA State House of Representatives and PA State Senate. 

Fred Gaffney, Columbia Montour Chamber president, introduced the panel to the class:

Following brief introductions by Gaffney, the class then learned why each of the panelists ran for office, that running for office can be discouraging, rewarding and challenging, and that the public does not know what happens in an election tie until the last ball is drawn. Each person on the panel had personal reasons for entering politics.  It was refreshing to hear, unlike in many times in national media, about what they are trying to do to improve our local communities.

The panel also shared issues they face, mostly from unfunded state and federal mandates. These are mandates related to education, the environment, public domain, industry, and public safety, just to name a few. More and more, there are laws and regulations that force issues down to the local level for implementation and enforcement. Issues like teacher pensions, flood protection, environmental monitoring and water run-off regulations were discussed. 

Later in the morning the panel was joined by two state officials: 

  • John Gordner, PA State Senator
  • David Millard, PA House of Representatives

After introductions, it was time to discuss governmental transparency, budget and election gerrymandering. These topics, of course, were ripped from the headlines. This led to discussions related to constitutional law, and how Pennsylvania is one of a handful of states facing election issues as we prepare for primary season and midterm elections. These issues will cause debate about judicial versus legislative powers that will most likely reach the Supreme Court.

The one thing missing from the morning was partisan politics. It was refreshing to hear a group of elected officials discuss topics in a succinct way using facts and common sense, with the end goal being what is best for their constituents and people of Pennsylvania. Oftentimes, we get lost in partisan pandering and the daily media news cycle, and it is nice to see behind the local and state curtains, and realize these are good people doing the best they can.     

After another wonderful lunch prepared by Lucy’s Kitchen & Catering, it was time to introduce Christine Pangelinan, program officer at the Central Susquehanna Community Foundation. She was able to educate the class on the advantages of community foundations, and their impact on our area. There was a fun game involving teamwork to identify key terms used by foundations, and a scavenger hunt to learn about the CSCF.  Christine then asked if anyone won $1 million and had to set up a community fund through a community foundation, what would they do? There was great enthusiasm as the class then created their own community funds. These funds needed to be named, focused and a type was chosen (e.g. donor advised fund, agency endowment fund, scholarship fund, designated fund, pass through fund). The class really impressed Christine with their creative and thoughtful approaches, organization and naming of these funds.

Leo Gilroy, director of strategy & innovation at NEPIRC, leads the class through a presentation on change management.

As the afternoon wore on, it was time for a change, literally and figuratively. The class was introduced to Leo Gilroy, director of strategy & innovation with the Northeastern Pennsylvania Industrial Resource Center (NEPIRC). The class had individual opportunities to introduce themselves and discuss issues they have seen related to change at their organizations.  One thing everyone learned is that change is necessary, but not always easy.  However, the hardest changes can be the most beneficial, and communication is the main key to success in all organizations.

Leo then walked through a presentation highlighting the “5 Dimensions of Leading Change, Flexibility, Change and Teamwork,” “The Heart of Change (8 steps)” and “The Power of Habit.” In the end, human beings are biased toward the status quo, and all have heard the saying, “well, that is the way we’ve always done it.” People change radically only when they overcome instincts to stay in the comfort zone. Creating a culture of change is hard, but the payoff will be a flexible and agile organization ready to take on planned and unforeseen changes as they arrive.

Leadership Central Penn is sponsored by Bloomsburg UniversityKawneerSEKISUI SPI and USG

Downtown Improvement Plans Moving Forward in Berwick, Bloomsburg & Danville

Rich Kisner, executive director of Community Strategies Group, informed state and local agencies and elected officials about several significant projects being pursued for Berwick’s downtown area.

Efforts to enhance the downtown commercial districts in Berwick, Bloomsburg, and Danville are moving forward.

On Thursday, Feb. 22, the Berwick: The Next Step steering committee met with representatives of state and federal agencies as well as elected officials to provide an overview of the downtown enhancement plan. Several significant projects are currently being pursued and the meeting was to help identify funding opportunities for those projects. The Chamber provided funding for the enhancement plan and is part of that steering committee that meets every other week to advance the plan. Community Strategies Group is coordinating the effort.

Downtown Bloomsburg Inc., the Chamber’s subsidiary organization, is requesting approval from the Town of Bloomsburg to apply for grant funding to convert Miller Avenue into a primarily pedestrian walkway and gathering place. Ideas include tables and chairs serviced by the adjacent restaurants, and additional lighting to enhance safety between Main Street and the municipal parking lot. The project was identified the downtown Bloomsburg enhancement plan coordinated by DBI and supported by The Chamber.

In Danville, funding for the development of Canal Park next to Borough Hall has been awarded by the Pennsylvania Department of Community and Economic Development. The plan includes seating and a stage area for live performances. That project is a collaboration between the Borough of Danville and Danville Business Alliance.

First Week of Budget Hearings Zeros in on Spending Plan Specifics, Job Creation

From PA Chamber of Business & Industry

The first of two weeks of budget hearings was held last week, as lawmakers on the House and Senate Appropriations Committees met with the heads of state agencies and state row offices to discuss the proposed appropriations in Gov. Tom Wolf’s 2018-19 state budget, current issues facing each department and what they foresee coming up in the year ahead.

One of the first hearings – the House Appropriations Committee’s hearing with the Independent Fiscal Office – focused partly on the governor’s proposed severance tax on the natural gas industry. IFO Deputy Director Mark Ryan stated that the cost of implementing a new severance tax – which would be in addition to the existing impact tax – would amount to $17 million. Several Republicans on the committee expressed their disagreement with the administration over raising taxes to generate more revenue. The PA Chamber agrees that a severance tax – which unfairly singles out the natural gas industry – is both unfair and hurts the state’s economic competitiveness, which is why our organization is leading a broad-based coalition in opposition to higher energy taxes in this year’s budget negotiations. The IFO also said that while Gov. Wolf’s proposed increase in the minimum wage to $12 an hour would generate more spending and economic activity, it could come at a price – it is likely that the hike in minimum wage would also decrease jobs. In fact, last year, the IFO studied the impact of a minimum wage increase and found that it would cost the state about 54,000 jobs and raise $60 million less than proponents thought it would.

The House Appropriations Committee also focused its attention on job creation at hearings with the Department of Community and Economic Development and the Department of Labor and Industry last week. According to a Capitolwire story, Committee Chairman Stan Saylor, R-York, said he wanted to “take a deep dive into the effectiveness of our current programs for job creation,” stating his belief that money dedicated toward the state’s Workforce Development Board would be better spent on direct job training. Secretary Dennis Davin of DCED and Secretary Jerry Oleksiak of L&I spoke up in support of Gov. Wolf’s proposal to increase funding for a new state Apprenticeship and Training office and boosting spending within the Industry Partnerships program by $3 million in next year’s budget.

According to both secretaries, the extra apprenticeship program funding would be used to double the number of registered apprentices working in manufacturing, businesses and the labor trades and expand apprenticeship opportunities for youth and adults. They mentioned the Shell cracker plant in Beaver County as an example of a place where new manufacturing jobs will be created, and that skilled workers will be needed to fill them.  They also discussed legislation that aims to consolidate workforce development programs within L&I, DCED and the Department of Human Services to maximize their effectiveness. “This proposal would give DCED, the agency that is tasked with keeping current employers in Pennsylvania and bringing new opportunities into the state, the much-needed tools to help connect employers who have job openings with workers qualified to fill them,” said the bill sponsor, Rep. Justin Walsh, R-Westmoreland.

At the Senate Appropriations budget hearing with the Department of State, the ongoing issue of the state’s Congressional maps was raised and there was some controversial discussion when Acting Secretary Robert Torres said that the administration does not intend to publish in every county the maps that were imposed by the state Supreme Court last Monday – and that they would focus on sharing the information through press releases, the DOS website and social media. “You’ve changed the maps in the state. Even if the Supreme Court doesn’t order it, I believe the voters should know where they are within those districts, and the maps should be published,” said Sen. Mario Scavello, R-Monroe.  According to a Capitolwire story on the hearing, Jonathan Marks, commissioner of the Bureau of Commissions, Elections and Legislation, said that the issue is publishing maps in newspapers in every county, as is required in Pennsylvania statute under normal circumstances. “When a redistricting plan is enacted, there’s a publication requirement …. Where you would publish in two newspapers of general circulation in every county,” Marks said. “The Court has not mandated that … at least not yet, but we are using other avenues to get the word out to voters.”

Budget hearings will continue all this week. The Senate Appropriations Committee is hosting all of its budget hearings in Hearing Room 1 of the North Office Building in the state Capitol; while the House Appropriations Committee is holding all of its hearings in Room 140 of the Main Capitol Building. The budget hearing schedule, which is subject to change, is available on the General Assembly website; the PA Chamber will be reporting noteworthy information from these hearings in next week’s edition of Sentinel.

EEOC Wellness Rules Have Short Shelf Life

From ChamberChoice

It seemed like it had taken the EEOC forever to issue regulations as to whether employers could provide employees an incentive to participate in a wellness program and still have the program be voluntary. The issue of “voluntary” is important because under the Americans with Disabilities Act (ADA) any wellness program that includes a disability-related inquiry and/or medical exam, participation must be voluntary. The same rule is applicable to any information that is protected under the Genetic Information Nondiscrimination Act (GINA).

In July 2016, the EEOC issued long awaited rules under the ADA and GINA relating to wellness plans. The rule provided that employers could implement penalties or incentives, limited to 30 percent of the cost of self-only coverage, to encourage employees to disclose ADA protected information and certain genetic information without causing the disclosure to be involuntary. These rules were applicable to plans beginning on or after Jan. 1, 2017.

Since then, the EEOC rules have been challenged by AARP. The AARP’s claim is that the 30 percent incentive or penalty still renders participation involuntary, since there could be some employees unable to pay the penalty and in effect forced to provide the protected information. The court agreed with AARP finding that the EEOC was arbitrary and did not provide enough evidence in its rulemaking to justify the 30 percent rule.

The court sent the rules back to the EEOC for further review and analysis. In the meantime, after the court’s decision was issued, AARP requested the court to reconsider its decision and vacate (render void) the EEOC’s regulations, to which the court agreed.

Vacating of the rules is not effective until Jan. 1, 2019. Therefore, the current rules permitting the 30 percent incentive/penalty remain in place during 2018. The EEOC has not indicated a time frame for the provision of new rules. Therefore employers will want to stay on top of this issue as to the future operations or offering of any wellness programs.

In conclusion, employers may stay the course for its wellness program in 2018. However, due to the vacating of the EEOC incentive rules, 2019 will bring new rules. As it relates to wellness programs, employers should remember that there are separate applicable rules under the Health Insurance Portability and Accountability Act (HIPAA). The HIPAA wellness rules are not affected by the vacating of the EEOC rules.